Aims: Although overall U.S. stroke mortality rates have declined significantly since the 1950s, stroke rates remain high for African-Americans (AA). Disparities are most evident in those ≤65, and AA/white mortality ratio among men aged 45-54 years is 3.7. Care approaches targeting young AA men could improve disparities. This National Institute of Health (NIH)-funded study compared a novel behavioral TargetEd MAnageMent Intervention (TEAM) vs. treatment as usual (TAU) in 38 young (< age 65) AA men with stroke or TIA.
Methods: A community- engaged process was used to refine an existing behavioral intervention. Participants were then randomly assigned to TEAM (N=19) or TAU (N=19). TEAM was assessed for feasibility, acceptability, and fidelity, and efficacy in comparison to TAU on medication adherence, stroke risk factors (blood pressure, diabetes control/HbA1c, lipids) and health behaviors. Qualitative assessment evaluated the perspectives of intervention participants.
Results: Sample mean age was 52.1 (SD 7.4). Half had TIA and half had stroke. Mean body mass index was 31.4 (SD 7.4). Baseline systolic blood pressure mean was 129 (SD 16.6) and diastolic mean was 84 (SD 11.1). Baseline non-adherence (missed medication) was only 5.9% (SD 14.4). There were 14/38 (36.8%) with diabetes, with mean HbA1c of 8.0, SD 1.8. Baseline serum lipids were all within desirable targets. At 12 weeks, TEAM participants had a significantly lower rate of hypertension. This difference was maintained at 24 weeks, but was no longer statistically significant. Mean systolic pressure was significantly lower in TEAM at 24 weeks (p =.03), and diastolic pressure was lower in TEAM at 12 weeks compared to TAU (p <.05). HDL cholesterol was better in TEAM at 24 weeks (p=.03). Other biomarker and health behaviors were similar between groups. While mean HbA1c was not assessed in TAU due to small sample size, HbA1c improved in TEAM. There was minimal improvement in adherence. Qualitative results suggested improved awareness of risk factors as well as positive effects of group support.
Conclusions: TEAM can engage AA men, and has potential to improve stroke risk-factors. Qualitative findings suggest that effects might be enhanced with a slighter longer duration and including older AA and women.